All posts by Laura Suzanne Bishop

A national ideal of health: how to intervene

The growing obesity epidemic raises concerns in many sectors from healthcare to the food industry and even the business sector, and S. Holm considers the place of ethics within these conversations about interventions to combat obesity. “Obesity Interventions and Ethics” brings up the controversial debate whether health is good for everyone, regardless of individuals’ values. Similar to the conversation about informed consent, obesity interventions involve a conflict of values between autonomy, respect for personal choices, and promotion of the common good.  Current policies such as the FDA’s forced phase out of trans fats by the food industry assume that being healthy is good for all citizens.[i] Governmental control on health and health decisions could be supported by the constitutional clause on promotion of general welfare. [ii] This argument of constitutional responsibility gives broad authority to the government to promote the general welfare, and in this context, general welfare could be seen as health. This sort of argument framework has been utilized in the debate on healthcare in the United States. Our nation is making a transition towards universal healthcare by enacting the Affordable Care Act. Therefore, our government is making claims that health is an important right and aspect of citizenship. Our nation is associating health with what is “good” and society members through payments and taxes are supporting this notion by merely being members of society.

In contemporary times, personal freedom is gaining emphasis as seen in the case of informed consent, and therefore, freedom surrounding people’s choices about their health and nutrition will be increasingly scrutinized.[iii] Current times will involve interesting interchange between personal freedoms and government promotion of health for all. There are nuances between government encouraging healthy choices and controlling the choices that society members make. For example, the FDA’s forced phase out of trans fats represents governmental control, or hard paternalism as defined by Finnish philosopher Heta Hayry. There is importance in Heta Hayry’s clever distinctions between the levels of paternalism: hard paternalism, soft paternalism, and maternalism, and these differing levels could be an important marker for evaluating public health policies. Soft paternalism and materialism are the most favorable because these still allow for pursuit of personal choice.  A health campaign out of Hawaii, “Rethink Your Drink,” cultivates repugnance in soda drinkers by using controversial advertising techniques.[iv] This matneralistic  method is more favorable in terms of the consumers’ freedoms and adherence and compliance. In comparison, Mayor Bloomberg’s proposed ban on sugary drinks which was seen as an overstep of power and was not passed due to its hard paternalistic nature. Instead of instilling empowerment and change, the law was challenged and ended in a victory for soda drink makers.[v] In context to the national assumption of health as good as mentioned previously, then I do believe that these acts of soft paternalism or maternalism are justified.


I think Holm’s article makes a good point about soft paternalism and maternalism but I think there needs to be a parallel focus on issues of accessibility and affordability for good health options and information. Quality interventions should deal with these aspects, and only when these areas are covered can an individual bear all responsibility for his or her own decisions. Holm’s mentions the circular and continuous debate over who holds responsibility for the obesity epidemic. Analysis in context to the constitutional argument, the United States bears a portion of responsibility in the individual’s choice. Therefore, an appropriate and efficient intervention will need to ensure that options presented are affordable, accessible (in terms of both material items and information) as well as not presented in a controlling manner.  Environment has a huge influence on how people make decisions, and soft paternalism or maternalism interventions can only initiate movement for change if certain things, such as food options, are available or affordable or else these interventions are in vain. The “Rethink your Drink” campaign was a success because the means for the campaign are available to all—cutting out sugary drinks and replacing them with water.

Thus, in order for a soft paternalistic or maternalistic intervention to be a success people need to have the means to follow through with the behavioral changes and from there on out, the responsibility lies in the hands of the consumer. As with discussion about informed consent, from this point there needs to be respect for the consumer’s decision, especially in this ideal intervention method.  While I believe these other aspects of the intervention technique are possible, I think respect will be the largest issue in applicability. Holms highlights this issue through conversation about stigmatization; respect is difficult to cultivate when people misunderstand other’s choices and tradeoffs or an individual’s sense of well-being.

[iii] Veatch, Robert M. Abandoning Informed. Arguing About Bioethics. By Stephen Holland. New York: Routledge, 2012. 329-38. Print.



Public Health and Respect for Personal Autonomy

Applying ethical principles to the medical field has proven complex, as highlighted by James Childress in his writings on the complexities of adhering to respect for personal autonomy.[1] The philosophical discipline of bioethics is not narrowly tied to medicine, but expands to cover medical anthropology, medical sociology, health politics, health economics, research, public health policy, and more.[2] Public health aims at improving the health of the community as a whole, and public health initiatives usually involve preventative measures that prolong life and promote health. Generally, public health policy concerns itself with health based on population-level health analysis.  Thus, how do ethical principles change when the policy is focused on net benefit for the community, instead of focusing on individual community members?

Concentration on the group needs and health leads to thinking that often forgets about individual rights, but ethical principles of the individual need to be remembered when applying public health policies. Historically, individual rights are becoming increasingly recognized, and in the medical field, consent is a twentieth-century phenomenon.[3] As medicine increasingly recognizes individual rights, it is a logical extension for public health as a discipline to acknowledge analogous rights.

In bioethics, consent is rooted in the ethical principle of respect for personal autonomy, but this principle is complex and limited in application. Childress in “The Place of Autonomy in Bioethics” presents the scope of applicability of the principle of autonomy in medicine. He argues that first and foremost respect for autonomy of persons differs from people who are not autonomous such as children (unspecified age range) and the insane. Also, respect for autonomy must coincide with other necessary ethical principles such as beneficence and care, and in certain circumstances, ethical principles can outweigh or override one another. Thus, under certain circumstances the principle of respect for personal autonomy may be infringed upon, and specifically, the realm of public health needs to consider if policies made for the benefit of the group reasonably infringe upon the personal autonomy of group members.

The political cartoon depicts the modern-day anti-vacccination “epidemic.” This so-called epidemic is happening parallel to increasing focus on individual rights. Our generation will have to consider how much public health can infringe upon personal autonomy of our society’s citizens. (Source:

This past September, 750 students in Winston-Salem, NC faced suspension after not adhering to state vaccination policies for the Tdap vaccination that protects against tetanus, diphtheria and whooping cough or pertussis.[4] Cases of mandatory vaccinations represent paternalistic interventions where interference with an individual’s liberty may be justified by reasons such as welfare, happiness, values, interests, and needs of the person being coerced. Mandatory vaccination initiatives are public heath measures that override rights of respect for personal autonomy for the sake of containing and preventing infection and disease. In context to this case, paternalism functions off the principle of beneficence. Mandatory vaccinations highlight the conflicts between moral principles, and under these circumstances, I think beneficence overrides each group member’s autonomy. While privacy and confidentiality can still be protected, controlling the spread of disease and preventing illness in community members is a moral call to action for vaccination. While it may be easier to fully respect the autonomy of an individual patient than an entire population, public health policy still should not deprive individuals of their rights without thoughtful consideration. Following Childress’s logic, are all group members considered equally autonomous thus infringement upon personal autonomy is the same? Or, based on group status does infringement on personal autonomy have different implications? In modern times, awareness of personal rights is increasing within bounds; therefore, it is important for public health to grasp and debate these ethical concerns. A new interpretation could view mandatory consent as a prior consent based on group membership, and thus interference is the price of group membership.[5]  Such a viewpoint believes that the individual’s interests are still considered, but an individual is accepting his or her role as a group member. Future public health policies could work to understand the line between respect for personal autonomy and social responsibility, and from there, public health can define its realm of action and control.


[1] Childress, J. F. “The Place of Autonomy in Bioethics”

[2] Benatar, D. Bioethics and health and human rights: a critical view. Journal of Medical Ethics. 2006 January; 32(1): 17-20.

[3] Veatch, R. M. “Abandoning Informed Consent”


[5] Hall, Spencer. Should public health respect autonomy? Journal of Medical Ethics. 1992. 18: 197-201.

Cloning: hard cases can make bad laws

The reality of cloning is now a global phenomenon, and as technologies improve the possibility of human cloning becomes more plausible. The use of cloning to manufacture, as mentioned by both Leon Kass and David Elliot in Arguing about Bioethics, exists in the realm of animal technologies, and eerily, China is now cloning pigs on an “industrial scale” ( The photo below depicts the mass production of pigs that is now possible due to genetic cloning. Therefore, there is only a short time until human cloning is efficient and safe enough to enter the market place. Interestingly within the United States, individual states take different stances on cloning, and cloning boundaries are blurred across the nation. (, ). As technological advances further blur lines, there needs to be conversation on the moral boundaries of cloning as a form of “assisted reproduction,” and critical engagement is necessary to translate moral standards into public policy that will govern scientific procedures.


Cloning takes the discussion of human experimentation another step further, and challenges the ethical line of human subject experiments. The first cases of cloning would be all encompassing biological, genetic, social, and procreation experiments. Science has already taken baby steps towards further human experimentation such as cloning through techniques like prenatal genetic screening and parental genetics testing. This brings up debates about selection, the power of positive selection, and what can be categorized as too much selection (Holland 153) David Elliot in “Uniqueness, Individuality, and Human Cloning” presents a weak objection to the manufacturing argument, and instead he argues, “It can simply be a choice to have a child of one’s own in the only way possible” (Holland 153). Elliot’s counterargument against the manufacturing objection highlights defendable and seemingly reasonable motivations for cloning, such as infertility or genetic diseases, and he overlooks unreasonable motivations for positive selection, such as for control over sex, intelligence, or beauty. This reasoning treads a dangerous path, and the President’s Council on Bioethics warns “hard cases can make bad laws” ( Therefore, it is essential to look beyond the logical and sensible cases that seem to necessitate cloning, to cases of inappropriate and dangerous motivations. Difficult life circumstances relating to fertility can blind a society, or an individual, of the moral implications of bringing new life into this world (

Thus, evaluation of cases of cloning will involve prudence. There are recognizable and defendable motivations to clone in order to produce a child, but no one can articulate how much control and design selection amounts to a product, rather than a child. Tough cases can make bad laws, and it will be a societal test for how justifications like those presented by Elliot will affect public policy and laws.

Joyelle Flemming in her previous blog post brings up interesting considerations about the repercussions of cloning on the future. While in time our generation or future generations may come at accept cloning as a form of reproductive assistance, how will this impact future generations and the relationship of science and society? Cloning conversations must address the implications on the future and how man-made selection through cloning will effect the development of the human species as well as the world. While there is no perfected cloning technique to date, considerations of the morality of cloning should address cloning in context to the present as well as projected techniques.



Elliot, David. “Uniqueness, individuality, and human cloning.” Arguing about Bioethics. London: Routledge, 2012. Print.

“Human Cloning Laws.” Human Cloning Laws. National Conference of State Legislatures, Jan. 2008. <>.

“Human Cloning and Human Dignity: An Ethical Inquiry — Full Report.” PCBE: Human Cloning and Human Dignity: An Ethical Inquiry — Full Report. The Presidents Council on Bioethics, July 2002. Web. <>.

Kass, Leon R. “Why We Should Ban the Cloning of Humans: The Wisdom of Repugnance.” Arguing about Bioethics. London: Routledge, 2012. Print.

Nikas, Nikolas T. “Human Cloning Laws: 50 State Survey.” Bioethics Defense Fund, 19 May 2011. Web. <>.

Shukman, David. “China Cloning on an ‘industrial Scale'” BBC News. BBC, 14 Jan. 2014. Web. 26 Jan. 2014. <>.